Lack of access and continuity of adult health care: a national population-based survey

OBJECTIVE To describe the lack of access and continuity of health care in adults.METHODS A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided by a doctor, by other health professional or home care in the last three months). Based on the results obtained by the description of the sample, a projection is provided for adults living in Brazilian urban areas.RESULTS The highest prevalence of lack of access to health services and to provision of care by health professionals was for hospitalization (3.0%), whilst the lowest prevalence was for care provided by a doctor (1.1%). The lack of access to care provided by other health professionals was 2.0%; to accident and emergency services, 2.1%; and to home care, 2.9%. As for prevalences, the greatest absolute lack of access occurred in emergency care (more than 360,000 adults). The main reasons were structural and organizational problems, such as unavailability of hospital beds, of health professionals, of appointments for the type of care needed and charges made for care.CONCLUSIONS The universal right to health care in Brazil has not yet been achieved. These projections can help health care management in scaling the efforts needed to overcome this problem, such as expanding the infrastructure of health services and the workforce.

Dose-dependent positive association between cigarette smoking, abdominal obesity and body fat: cross-sectional data from a population-based survey.

ABSTRACT: BACKGROUND: Although smokers tend to have a lower body-mass index than non-smokers, smoking may favour abdominal body fat accumulation. To our knowledge, no population-based studies have assessed the relationship between smoking and body fat composition. We assessed the association between cigarette smoking and waist circumference, body fat, and body-mass index. METHODS: Height, weight, and waist circumference were measured among 6,123 Caucasians (ages 35-75) from a cross-sectional population-based study in Switzerland. Abdominal obesity was defined as waist circumference>=102 cm for men and >=88 cm for women. Body fat (percent total body weight) was measured by electrical bioimpedance. Age- and sex-specific body fat cut-offs were used to define excess body fat. Cigarettes smoked per day were assessed by self-administered questionnaire. Age-adjusted means and odds ratios were calculated using linear and logistic regression. RESULTS: Current smokers (29% of men and 24% of women) had lower mean waist circumference, body fat percentage, and body-mass index compared with non-smokers. Age-adjusted mean waist circumference and body fat increased with cigarettes smoked per day among smokers. The association between cigarettes smoked per day and body-mass index was non-significant. Compared with light smokers, the adjusted odds ratio (OR) for abdominal obesity in men was 1.28 (0.78-2.10) for moderate smokers and 1.94 (1.15-3.27) for heavy smokers (P=0.03 for trend), and 1.07 (0.72-1.58) and 2.15 (1.26-3.64) in female moderate and heavy smokers, respectively (P<0.01 for trend). Compared with light smokers, the OR for excess body fat in men was 1.05 (95% CI: 0.58-1.92) for moderate smokers and 1.15 (0.60-2.20) for heavy smokers (P=0.75 for trend) and 1.34 (0.89-2.00) and 2.11 (1.25-3.57), respectively in women (P=0.07 for trend). CONCLUSION: Among smokers, cigarettes smoked per day were positively associated with central fat accumulation, particularly in women.

Clustering of risk behaviors with cigarette consumption: a population-based survey.

OBJECTIVE: This study assessed clustering of multiple risk behaviors (i.e., low leisure-time physical activity, low fruits/vegetables intake, and high alcohol consumption) with level of cigarette consumption. METHODS: Data from the 2002 Swiss Health Survey, a population-based cross-sectional telephone survey assessing health and self-reported risk behaviors, were used. 18,005 subjects (8052 men and 9953 women) aged 25 years old or more participated. RESULTS: Smokers more frequently had low leisure time physical activity, low fruits/vegetables intake, and high alcohol consumption than non- and ex-smokers. Frequency of each risk behavior increased steadily with cigarette consumption. Clustering of risk behaviors increased with cigarette consumption in both men and women. For men, the odds ratios of multiple (> or =2) risk behaviors other than smoking, adjusted for age, nationality, and educational level, were 1.14 (95% confidence interval: 0.97, 1.33) for ex-smokers, 1.24 (0.93, 1.64) for light smokers (1-9 cigarettes/day), 1.72 (1.36, 2.17) for moderate smokers (10-19 cigarettes/day), and 3.07 (2.59, 3.64) for heavy smokers (> or =20 cigarettes/day) versus non-smokers. Similar odds ratios were found for women for corresponding groups, i.e., 1.01 (0.86, 1.19), 1.26 (1.00, 1.58), 1.62 (1.33, 1.98), and 2.75 (2.30, 3.29). CONCLUSIONS: Counseling and intervention with smokers should take into account the strong clustering of risk behaviors with level of cigarette consumption.

The association between cigarettes smoking, cannabis use and alcohol consumption in a population of young men: results of a population-based survey.

BACKGROUND: Cigarette smoking is often initiated at a young age as well as other risky behaviors such as alcohol drinking, cannabis and other illicit drugs use. Some studies suggest that cigarette smoking may have an influence on other risky behaviors but little is known about the chronology of occurrence of those different habits. The aim of this study was to assess, by young men, what were the other risky behaviors associated with cigarette smoking and the joint prevalence and chronology of occurrence of those risky behaviors. METHODS: Cross-sectional analyses of a population-based census of 3526 young men attending the recruitment for the Swiss army, aged between 17 and 25 years old (mean age: 19 years old), who filled a self reported questionnaire about their alcohol, cigarettes, cannabis and other illicit drugs habits. Actual smoking was defined as either regular smoking (¡Ý1 cigarette/day, on every day) or occasional smoking, binge drinking as six or more drinks at least twice a month, at risk drinking as 21 drinks or more per week, recent cannabis use as cannabis consumption at least once during the last month, and use of illicit drugs as consumption once or more of illicit drugs other than cannabis. Age at begin was defined as age at first use of cannabis or cigarette smoking. RESULTS: In this population of young men, the prevalence of actual smoking was 51.2% (36.5% regular smoking, 14.6% occasionnal smoking). Two third of participamnts (60.1%) declared that they ever used cannabis, 25.2% reported a recent use of cannabis. 53.8% of participants had a risky alcohol consumption considered as either binge or at risk drinking. Cigarette smoking was significantly associated with recent cannabis use (Odds Ratio (OR): 3.85, 95% Confidence Interval (CI): 3.10- 4.77), binge drinking (OR: 3.48, 95% CI: 3.03-4.00), at risk alcohol drinking (OR: 4.04, 95% CI: 3.12-5.24), and ever use of illicit drugs (OR: 4.34, 95% CI: 3.54-5.31). In a multivariate logistic regression, odds ratios for smoking were increased for cannabis users (OR 3.10,, 95% CI: 2.48-3.88), binge drinkers (OR: 1.77, 95% CI: 1.44-2.17), at risk alcohol drinkers (OR 2.26, 95% CI: 1.52-3.36) and ever users of illicit drugs (OR: 1.56, 95% CI: 1.20-2.03). The majority of young men (57.3%) initiated smoking before cannabis and mean age at onset was 13.4 years old, whereas only 11.1% began to use cannabis before smoking cigarettes and mean age at onset was slightly older (14.4 years old). 31.6% started both cannabis and tobacco at the same age (15 years old). About a third of participants (30.5%) did have a cluster of risky behaviours (smoking, at risk drinking, cannabis use) and 11.0% did cumulate smoking, drinking, cannabis and ever use of illegal drugs. More than half of the smokers (59.6%) did cumulate cannabis use and at risk alcohol drinking whereas only 18.5% of non-smokers did. CONCLUSIONS: The majority of young smokers initiated their risky behaviors by first smoking and then by other psychoactive drugs. Smokers have an increased risk to present other risky behaviors such as cannabis use, at risk alcohol consumtion and illicit drug use compared to nonsmokers. Prevention by young male adults should focus on smoking and also integrate interventions on other risky behaviors.

The PsyCoLaus study: methodology and characteristics of the sample of a population-based survey on psychiatric disorders and their association with genetic and cardiovascular risk factors.

ABSTRACT: BACKGROUND: The Psychiatric arm of the population-based CoLaus study (PsyCoLaus) is designed to: 1) establish the prevalence of threshold and subthreshold psychiatric syndromes in the 35 to 66 year-old population of the city of Lausanne (Switzerland); 2) test the validity of postulated definitions for subthreshold mood and anxiety syndromes; 3) determine the associations between psychiatric disorders, personality traits and cardiovascular diseases (CVD), 4) identify genetic variants that can modify the risk for psychiatric disorders and determine whether genetic risk factors are shared between psychiatric disorders and CVD. This paper presents the method as well as somatic and sociodemographic characteristics of the sample. METHODS: All 35 to 66 year-old persons previously selected for the population-based CoLaus survey on risk factors for CVD were asked to participate in a substudy assessing psychiatric conditions. This investigation included the Diagnostic Interview for Genetic Studies to elicit diagnostic criteria for threshold disorders according to DSM-IV and algorithmically defined subthreshold syndromes. Complementary information was gathered on potential risk and protective factors for psychiatric disorders, migraine and on the morbidity of first-degree family members, whereas the collection of DNA and plasma samples was part of the original somatic study (CoLaus). RESULTS: A total of 3,691 individuals completed the psychiatric evaluation (67% participation). The gender distribution of the sample did not differ significantly from that of the general population in the same age range. Although the youngest 5-year band of the cohort was underrepresented and the oldest 5-year band overrepresented, participants of PsyCoLaus and individuals who refused to participate revealed comparable scores on the General Health Questionnaire, a self-rating instrument completed at the somatic exam. CONCLUSIONS: Despite limitations resulting from the relatively low participation in the context of a comprehensive and time-consuming investigation, the PsyCoLaus study should significantly contribute to the current understanding of psychiatric disorders and comorbid somatic conditions by: 1) establishing the clinical relevance of specific psychiatric syndromes below the DSM-IV threshold; 2) determining comorbidity between risk factors for CVD and psychiatric disorders; 3) assessing genetic variants associated with common psychiatric disorders and 4) identifying DNA markers shared between CVD and psychiatric disorders.

Socio-economic variables influence the prevalence of inadequate nutrient intake in Brazilian adolescents: results from a population-based survey

Objective: To estimate the prevalence of inadequate nutrient intake among adolescents and the association between socio-economic variables and nutritional status. Design: Cross-sectional study with a population-based sample. Settings: The usual nutrient intake distribution was estimated using the Iowa State University method. The Estimated Average Requirement cut-off point method was used to determine the proportion of adolescents with inadequate intake for each nutrient, according to sex, income, parental educational level and nutritional status. Subjects: Twenty-four-hour dietary recalls were applied in 525 male and female Brazilian adolescents aged 14-18 years. Results: The highest prevalence of inadequate nutrient intake was observed for vitamin E (99% in both sexes). For male and female adolescents, the prevalence of inadequate intake was: Mg, 89% and 84%; vitamin A, 78% and 71 %; vitamin C, 79% and 53%; and vitamin B(6), 21% and 33%, respectively. The prevalence of inadequate intake for niacin, thiamin, riboflavin, Se, Cu and vitamin B(12) was <15 %. Individuals in the lower income and lower parental educational level strata had the highest risk of having inadequate intake for P, riboflavin and vitamins A, B(6) and B(12). Compared with non-overweight individuals, overweight individuals had a higher risk of inadequate intake for Mg, vitamin A, P, thiamin and riboflavin. Conclusions: The present study found a high prevalence of inadequate intake of nutrients that are recognised as being protective against chronic diseases. Adolescents in the lower income and lower parental educational level strata were less likely to have their nutrient intake requirements met.

Patterns of food acquisition in Brazilian households and associated factors: a population-based survey

Objective: To identify food acquisition patterns in Brazil and relate them to the sociodemographic characteristics of the household. Design: A cross-sectional national Household Budget Survey (HBS). Principal component factor analysis was used to derive food patterns (factors) on the basis of the acquisition of food classified into thirty-two food groups. Setting: The source of data originates from the 2002-2003 HBS carried out by the Brazilian Institute of Geography and Statistics between June 2002 and July 2003 using a representative sample of all Brazilian households. Subject: A total of 48 470 households allocated into 443 strata of households that were geographically and socio-economically homogeneous as a study unit. Results: We identified two patterns of food acquisition. The first, named `dual`, was characterized by dairy, fruit, fruit juice, vegetables, processed meat, soft drinks, sweets, bread and margarine, and by inverse correlations with Brazilian staple foods. In contrast, the second pattern, named `traditional`, was characterized by rice, beans, manioc, flour, milk and sugar. The `dual` pattern was associated with higher household educational level, income and the average age of adults on the strata, whereas the `traditional` presented higher loadings in less-educated households and in the rural setting. Conclusions: Dietary patterns described here suggest that policies and programmes to promote healthy eating need to consider that healthy and non-healthy foods may be integral in the same pattern.

Alcohol screening instruments in elderly male: a population-based survey in metropolitan São Paulo, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Nasal Carriage of Staphylococcus aureus in Botucatu, Brazil: A Population-Based Survey

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The association of HIV counseling and testing with HIV risk behaviors in a random population-based survey in Kisumu, Kenya.

HIV testing has been promoted as a key HIV prevention strategy in low-resource settings, despite studies showing variable impact on risk behavior. We sought to examine rates of HIV testing and the association between testing and sexual risk behaviors in Kisumu, Kenya. Participants were interviewed about HIV testing and sexual risk behaviors. They then underwent HIV serologic testing. We found that 47% of women and 36% of men reported prior testing. Two-thirds of participants who tested HIV-positive in this study reported no prior HIV test. Women who had undergone recent testing were less likely to report high-risk behaviors than women who had never been tested; this was not seen among men. Although rates of HIV testing were higher than seen in previous studies, the majority of HIV-infected people were unaware of their status. Efforts should be made to increase HIV testing among this population.

Nocturnal awakening with headache and its relationship with sleep disorders in a population-based sample of adult inhabitants of Sao Paulo City, Brazil

Our aim was to estimate the prevalence of nocturnal awakening with headache (NAH) in the population of Sao Paulo City according to gender, age (20-80 years old) and socioeconomic classes and its relationship to sleep disorders, sleep parameters, anxiety, depression, fatigue, life quality and obesity. We used a population-based survey with a representative three-stage cluster sample. Questionnaires and scales were applied face-to-face, and polysomnography was performed in 1101 volunteers, aged 42 +/- 14 years, 55% women. The complaint of NAH occurring at least once a week had a prevalence of 8.4%, mostly in women, obese subjects and those aged 50-59 years-old. We observed associations of NAH with insomnia, restless leg syndrome (RLS), nightmares and bruxism, but not obstructive sleep apnea syndrome. In a logistics regression model, risk factors for NAH were female gender, odds ratio (OR) (95% confidence interval [CI]) 4.5 (2.8-7.3); obesity, OR 1.9 (1.1-3.3); age between 50 and 59 years, OR 2.4 (1.2-4.7); severe anxiety, OR 8.1 (3.6-18.1); RLS, 2.7 (1.2-5.6); and nightmares, 2.2 (1.3-3.7). Our study shows that NAH was highly prevalent in the population of Sao Paulo and suggests that this phenomenon has specific characteristics with specific risk factors: obesity, RLS and nightmares.